Fred S Cloninger, OD

Primary specialty

OptometristTaxonomy code 152W00000X

License

804 Issued in NC

Practice address

406 S Broad St
Suite a
Gastonia, NC 28054-4304

Phone

(704) 865-3731

Fax

(704) 864-5736

NPI assigned

Sep 21, 2006

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Enrolled in NC

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1158796800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1222905600000",
    "number": "1508965161",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "406 S BROAD ST",
            "address_2": "SUITE A",
            "city": "GASTONIA",
            "state": "NC",
            "postal_code": "280544304",
            "telephone_number": "704-865-3731",
            "fax_number": "704-864-5736"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "406 S BROAD ST",
            "address_2": "SUITE A",
            "city": "GASTONIA",
            "state": "NC",
            "postal_code": "280544304",
            "telephone_number": "704-865-3731",
            "fax_number": "704-864-5736"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CLONINGER",
        "first_name": "FRED",
        "middle_name": "S",
        "credential": "OD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-09-21",
        "last_updated": "2008-10-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "NC",
            "license": "804",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "410009765",
            "state": "NC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "8909163",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Brett Standard Cleveland, MD
• Lavy Heng Clevenger, NP
• Paul Michael Clinard, D.D.S.
• Scott Michael Clinard, D.D.S.
• Karen Cline, RDH
• Karen Lynn Cloninger, MD
• Linda Beaty Cloninger, CCS
• Rebecca Elizabeth Clopp, FNP-C
• CMC-Northeast, Inc.
• CMG- Gaston Women'S Healthcare LLC

• Optometrist in Gastonia, NC
• Providers in Gastonia, NC by specialty
• Optometrist in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 2, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.